Healthcare: Critical Action Needed

Healthcare Politics Right Now

The need for a healthcare delivery system that both works and doesn’t cause major financial distress is high. As previously mentioned in The government is no longer working for us…, more than 25% of Americans say they are struggling seriously with their finances as a direct result of their medical bills.

Politicians have attempted to come up with alternatives to the current system that people would find acceptable, and so far, have been unsuccessful. While people like to blame the Affordable Healthcare Act for the increasing cost of healthcare expenditures, the fact is that they’ve been rapidly rising for decades (see image: Per capita health care expenditure 1960-2014 in the United States), something those who have been fortunate enough to have regular access to the healthcare system over that period of time would at least be subtly aware of. Even with the ACA, American’s rising healthcare expenses have not slowed.

We now have the GOP hiding behind closed doors while they develop health policies that impact every citizen in America, resulting so far in multiple leaks that illustrate their interests do not align with the interests of ordinary Americans. These are the same politicians whose leadership is prone to saying things such as, “Winners make policy and losers go home.” So far, everything that came out of this earlier in the legislative session has sounded like a disaster…and more recently, it’s even more of a disaster, finding multiple GOP members, scared about their re-election chances, backpedaling and saying they won’t be able to support it, as well as zero support from medical associations. The bill, “…represents a significant move in the wrong direction, resulting in fewer people having access to insurance, fewer patient protections and less coverage for essential behavioral health care,” according to Saul Levin, the American Psychiatric Association’s CEO and medical director.

We don’t need more politicians catering to special interests making health care policy for our country. What we need is for our politicians to deliver on something that actually works based on evidence that will actually work, modeling our system after systems throughout the world that are functional, affordable, and effective in their delivery of essential life and health services.

Some Issues a Functional, Affordable, and Effective System Would Solve

There are so many flaws with our current system that it is difficult to even begin summarizing them. Because what I’d really need to do is an entire series on the topic to effectively address the maladies under-addressed by our current situation, I am going to simply describe a handful of the dilemmas our current system does not address functionally, affordably, and effectively to help make this point.

Americans pay exorbitant rates for the services we obtain as compared on a like-for-like basis worldwide. The way we fund our healthcare, a hodgepodge system of medical plans, and the way our hospitals are consolidating care are both things that drive up costs. While there are those who say that this is just a competition thing, how is an ill consumer supposed to make choices that require a significant amount of research about things they have little understanding of in a way that they can benefit from competition? It’s more than enough for many that they have to make sense of the treatment options available to them. Even doctors having to deal with insurance companies, themselves, and bill their patients drives up costs considerably.

If you are on a health care plan tied to your place of employment, when you lose your job, you wind up paying the full cost at the same time that you have far less money to work with. Some may suggest “well, get on Medicaid.” It’s not really that simple. Consider this, people who have medical problems that result in work loss are in need of quality care from professionals familiar with their circumstances, and because the application process for Medicaid is long and complicated, people can go months without any treatment at all while they are working out their changes in coverage—resulting in them suffering more, being sicker longer, and perhaps, delaying critical treatments they depend on to save their lives. Having employment and medical insurance tied together easily can aversely impact someone’s overall health.

Having employment and medical insurance tied together can cause a host of additional problems, including, but not limited to:

Career stagnation: if a job is tied to medical, people may be unwilling to change jobs, risking changes in coverage deemed inadequate.

Undo employer influence: depending on the value an employer places on various medical practices, they can negatively impact coverage for care that most people would deem necessary. A perfect example of this is the Hobby Lobby lawsuit.

Marriages and Legal Partnerships: people may make the decision to marry simply to obtain better health care coverage, resulting in partnerships that may otherwise not be deemed beneficial.

Abuse: Sarah’s* medical insurance was provided through her estranged abusive spouse’s place of employment. With major medical issues, she intended to transfer directly to an AHA plan when allowed to do so via open enrollment, but was unable to, because he claimed he had not removed her from his plan when he actually had. By the time she learned what had happened, the “qualifying life event” clause that would have allowed her to transfer to another plan had been exceeded. She has been stuck paying out-of-pocket for both herself and her preschool-aged daughter until the next open enrollment period. This unholy marriage of employment and medical care actually allowed her abuser one more opportunity to harm her and her child that he otherwise would not have had.

Clearly, there are major problems with tying critical medical care to employment that are not being addressed by any of the policies that have gained any traction. If employers really wanted to “sweeten the pot” when offering coverage to their employees, as some tend to do, rather than having the entirety of one’s medical coverage attached to employment, we could allow employers to simply provide an additional “Cadillac-style” policy that adds to a nationwide single-payer system and everyone would have coverage and the above problems would not exist.

In addition to the aforementioned problems, there are gaps in coverage in places people least expect. Someone needs surgery and they go to a hospital only to find that while the hospital is covered, many of its specialists are not, and there is no way to ensure the specialist working on them in surgery is covered the same way that the hospital. People postpone critical procedures until they can afford astronomical co-pays, living in pain and even somewhat debilitated until the money can be procured. People need medicine critical to their health, but the copays are higher than they can afford. Our hodge-podge system of coverage is inadequate to cover the complexity of care Americans actually need.

Lastly, it’s important to keep in mind that without a comprehensive mental health care delivery system available at no or low cost to citizens with mental health needs, we are making things more difficult on everyone, as a whole. Mental health can greatly impact both someone’s work performance, as well as their future employability, meaning that a solid mental health care delivery system is critical to maintaining better job security for employees and better work productivity for employers. Yet, it is often one of the most difficult services to obtain, because the systems in place and the funding models are both inadequate to the need in nearly every community in America. When someone is unemployed, these systems are critical to getting back on one’s feet and contributing to productivity, and yet, that is when their affordability and accessibility often becomes the greatest difficulty.

Conclusion

In closing, our political system is not going to solve today’s medical system problems with the “solutions” being promoted by the closeted politicking going on. Our medical delivery system needs a complete overhaul. There are too many gaps, too many inefficiencies, and there are too many capitalistic beneficiaries of this system who are lobbying these same politicians behind closed doors for legislation that does not benefit ordinary Americans. If we want change, we are going to have to determine what that change looks like, and we are going to have to, as the American public, demand that the change that occurs will address the problems mentioned here, and that it is change that will work in our favor, not the favor of employers, or insurers whose base goals are to make money, rather than providing quality care to all Americans.